What is long COVID?
Long COVID does not have a single accepted definition, and there is no accepted definition or method for diagnosing it.
According to a report from the Centers for Disease Control and Prevention in June, nearly 1 in 5 Americans who had COVID-19 still experience long-term COVID symptoms, which are symptoms that appear more than three months after the infection but did not before. The CDC states that while long COVID is more common in people who experienced a severe bout of COVID-19, even people who experienced mild or asymptomatic cases can suffer from "post-COVID conditions." Long COVID symptoms range from respiratory and heart symptoms to neurological symptoms to general illnesses such as fatigue or muscle aches.
Three types of patients are seen at the hospital's long COVID clinic, according to Dr. Luis Ostrosky-Zeichner, chief of infectious diseases at UTHealth Houston and Memorial Hermann Hospital: those with lingering effects from a severe COVID-19 infection; those with underlying illnesses that were made worse by COVID-19; and "what we think of as true" long COVID patients, who have multiple symptoms for which we cannot currently find an objective cause."
The majority of the last category of long COVID patients, according to Ostrosky, improve on their own within four to six months.
But some of the patients we have been monitoring for a year or a year and a half have not made a full recovery. More investigation into their therapeutic options is required in that situation, he added.
What happens if you previously have COVID long and contract COVID-19 once more?
It can be a major setback for those who have been battling COVID for a long time, according to Ostrosky.
Ostrosky described the situation of some patients with lengthy COVID who relapsed with SARS-CoV-2 as "very terrible." "They may have made significant progress during this four to six-month healing process, but now they have suffered a significant setback. When this occurs, it is tremendously discouraging and demoralizing for them.
Although more study is still needed, self-reported instances can offer some insight into how reinfection affects those who already have lengthy COVID. In a recent online survey in the UK, 80% of participants who said they still had long-lasting COVID symptoms said that new incidence of COVID-19 made their symptoms worse.
About 60% of those in recovery or remission from long COVID experienced a reinfection; of these, 40% reported that the second bout of long COVID was equally severe to the first, 32% reported that it was less severe, and 28% reported that it was more severe.
According to the severity of the second episode of extended COVID, there is "a really wide range of experience," said Dr. Jessica Justman, an associate professor of epidemiology at Columbia University who was not involved in the survey. The conclusion was that if you now have or previously had long COVID, getting infected again may cause you to believe that your long COVID has worsened or returned. This gives you yet another reason to get immunized and take precautions to limit your exposures.
How can a second (or third or fourth) COVID-19 infection affect your chances of getting protracted COVID if you haven't had it before?
However, "some people can experience more severe COVID-19 during reinfection," according to the CDC, and the variety of circulating variants may mean that an individual may not have as much immunity from a prior infection as is typically the case. The CDC notes that symptoms from reinfection are likely to be less severe than those from the first infection.
In other words, even if you didn't get lengthy COVID the first time, you could still acquire it if you contract the virus again.
"Previous performance does not guarantee future results. You might have had a really mild case in the past, but there is no guarantee that the next case will be just as mild or will be more severe, according to Ostrosky.
Furthermore, we are still learning a lot about the damage that repeated infections do. Therefore, be on your watch.
Reinfection increased the risk of long COVID and other negative health outcomes, including a twofold increased risk of death and a threefold increased risk of hospitalization compared to those who were not reinfected, according to a study released last week that used data from the Department of Veterans Affairs' national health care database.
Without a doubt, senior author Ziyad Al-Aly stated in a press release that his research "showed that getting an infection a second, third, or fourth time contributes to additional health risks in the acute phase, meaning the first 30 days after infection, and in the months beyond, meaning the long COVID phase."
The study discovered that whether participants were uninfected, vaccinated, or boosted, reinfection increased odds of long COVID. But generally speaking, it's still unclear how immunization status affects long-term COVID outcomes. The CDC claims that persons who aren't vaccinated may be at higher risk of getting "post-COVID disorders" than those who are. However, another study by the same authors revealed that those who received the COVID vaccine were only 15% less likely to acquire extended COVID than those who weren't. According to other research, those who received the COVID vaccine twice reduced their risk of acquiring long-term COVID by half.
"This study should really be an eye-opener that shows us that there's still a lot to learn about the long-term consequences of multiple episodes of this infection," Ostrosky said. "For people that feel that 'I'm not going to die from COVID, it's OK to get multiple infections.
Justman emphasized that although the study offers more justifications for exercising extra caution and keeping up with vaccines, some results may have been overlooked due to the study's retrospective design. The study might have overlooked some people who were reinfected with SARS-CoV-2 but were asymptomatic or who tested positive for a mild case and didn't seek treatment because data on the participants was retroactively obtained rather than tracking them in real time. According to Justman, if such cases had been accurately counted, the risks of reinfection may have been reduced.
What will happen next?
While there is little known about long COVID and reinfection, as well as long COVID in general, a number of research are now being conducted that may soon provide some answers. To find out more about the long-term consequences of COVID-19, the National Institutes of Health is conducting a research called Researching COVID to Enhance Recovery (RECOVER). For a project titled "COVID-19: Understanding the Post-Viral Phase (COVID-UPP)," the CDC is working with partners, including Nova Southeastern University, to study patients who exhibit symptoms more than three months after contracting the virus.
There will be a lot of material released, so Justman advised people to "watch this space." "It's definitely a work in progress, but I think what we've discovered so far would reaffirm the same messages that everyone in public health keeps saying time and time again — which it feels like the public may not want to hear it anymore. It's still crucial to utilize all the immunizations you are eligible for, such as COVID boosters and the flu shot. And if you're in a crowded indoor area, consider your COVID exposure very carefully. If at all possible, attempt to use a mask.